Kendra's Miko 6/16 conservative Taiwan Dog; GRAD 8/11

Welcome Kendra!  

Good to hear pain meds were adjust to give comfort round the clock night and day.  If pain is not in control night and day, then  get back with the vet for further adjustments.

Prednisone is a KEY medication.  We'll need make sure we confirm and know  accurate information.

Date Pred started:   June 19th?
Doses on start date:  10mg    1x/day 
For How many days is this dose to be Rx'd prior to a reduction in mgs or times/ per day?

What country are you in?

There must be a reason for the neuro decline.  OFten is it can be due to an owner not realizing just how strict rest for the disc must be.  Too much movement can cause the disc to re-tear thus seriously impacting the spinal cord.

Let us know that you are on board with just how STRICT the rest must be:
    The hallmark component of conservative treatment is the very STRICT crate rest part (no PT, little movement). With little blood supply discs are much slower to form good scar tissue than it takes a blood rich broken bone to heal. Those weeks of a cast for a broken arm to heal is similar to the recovery suite being a kind of cast for the disc. 100% STRICT crate rest 24/7 for 8 weeks provides limited movement to allow good strong scar tissue to form.

▶︎ Super tried and true tips for setting up the recovery suite, the mattress and more! dodgerslist.com/2020/05/14/strict-rest-recovery-process

Knowledge is key!
Owner understanding ensures proper conservative treatment principals:
▶︎ 4 phases of healing, what it takes to heal each phase: dodgerslist.com/healing-the-disc/
▶︎ Roadmap for your fridge. Stay the course, avoid dangerous detours for the healing disc: dodgerslist.com/wp-content/uploads/2023/12/Roadmap-for-Fridge.pdf

STRICT rest means:
◼︎no laps ◼︎no couches ◼︎no baths ◼︎no sleeping with you
◼︎no chiro therapy 
◼︎no dragging legs at potty times.
◼︎no PT for conservative dogs during 8 weeks to heal disc

POTTY TIME strictness
If a 25lbs dog is too heavy for you to carry her in a safe way, one where she feels secure, then check out out our LARGE BREED care tips for other options for potty time.  Example,  pee pad is adjacent to the recovery suite.  Where only a few footsteps with front legs and use of a sling gets her to the pee pad.  More detail on this page:  dodgerslist.com/large-dog-care-tips-ivdd/

IF, you can safely carry her to potty:  
    Carry your dog to and from the recovery suite to the potty place and then allow a very, very few limited footsteps.
    Using a sling (long winter scarf, ace bandage, belt) will save your back and help to keep a wobbly dog's back aligned and butt from tipping over.

i0.wp.com/dodgerslist.com/wp-content/uploads/2020/04/Potty-leash-harness400-19kb.jpg

SNIFF and PEE TEST
The "sniff and pee test" is the only way for humans to determine whether bladder control exists. Carry the dog outdoors, set her down on an old pee spot for a sniff. Make sure that neither the sling nor your hands are on the stomach region as this could put pressure on the bladder. If urine comes out after sniffing, that is bladder control proof. 

Visualize your dog's neuro problem in 83 seconds.
Dr. Horsche, DVM explains intervertebral disc disease. IVDD can cause symptoms ranging from mild lower back pain to complete paralysis of the legs. Visualize how the spinal cord is impacted by a degenerated disc. As a dog moves, the vertebrae also move!


MONITORING NEURO FUNCTIONS and keep your vet updated by phone of any new or increased diminishment.
    There can be a predictable stepwise deterioration of functions if excessive back/neck movement for example.
     Nerves do heal in the exact opposite order nerve damage occured.
1. Pain with initial tear of disc and ensuing swelling
2. Wobbly walking
    legs cross
3. Nails/toes scuffing floor
4. _?_ Paws knuckle under. Dog is slow to correct or can't right the paw(s) at all
5. _?_Weak/little leg movement to be able reposition her body in the suite,
   _?__can't move up into a stand
6. ___Legs do not work at all (paralysis, dog is down)
7. ___ Bladder control is lost. Leaks on you when lifted. Can no longer sniff and then pee on that old urine spot outdoors.
8. __Tail wagging with joy is lost
9. __Deep pain sensation, the last neuro function, a critical indicator for nerves to be able to self heal after surgery or with conservative treatment.
    If surgery is not an option (for whatever reason) then the best option is conservative therapy.
    Surgery can still be successful in the window of 12-24 hours after loss of deep pain sensation. Even after that window of time, there can still be a good outcome. Each hour that passes decreases that chance.
    Precious hours can be lost with a general vet who gets DPS wrong. Trust only the word of a neuro (ACVIM) or ortho (ACVS) surgeon about DPS.
    🚩A quick overview of conservative treatment vs. a surgery:
dodgerslist.com/surgery-vs-conservative/
    🚩Dr. Isaacs indepth Interview on surgery and conservative treatment:
dodgerslist.com/dr-isaacs-surgery-answers/

Keep us posted on how Miko is doing.

Your vet is doing the right thing, double protecting the stomach lining with the switch over to the more powerful anti-inflammatory class....a steroid like Prednisone. Dogs can self heal their neuro damage with time. The SINGLE most important of care is that of STRICT Limited movement back Rest to allow the disc to self heal and not further compromise the spinal cord.

dodgerslist.com/bladder-bowel-care/
Leg dragging while pottying is bad. It just too much movement during a disc episode and could cause further injury to the healing disc. Since Miko is now okay with the sling, there should be no opportunity for dragging. She should be able to pee normally with the sling. The sling should not be covering the urethral area. If you find you cannot adjust the sling to avoid this, consider using a figure 8 sling. We have information about how to make one at the link below under potty time:
dodgerslist.com/strict-rest-recovery-process/

Kendra, here are some things you look at in addition to the handy tips in post above.

STOMACH issues
Be watchful for any signs of Prednisone damage (lip licking, nausea, not eating, loose stool, etc.)  
    Both omeprazole and Pepcid AC do the same thing---  suppress stomach acids. It takes omeprazole 3-5 days to reach peak efficiency then it is supposed to be very good.  Pepcid AC works in 30 mins.
   An Rx for 🚩Sucralfate would be the med to be added in should you detect any hint of GI issues starting to happen.  It works in a very different way than omeprazole and Pepcid AC.  It will be worth your while to be "in the know" about stomach protectors: dodgerslist.com/stomach-protection/   

SIZE of Recovery SUITE.  Do you have just a flat mattress that does not have the pillow sides to it?  The bolster is taking up precious suite space that Miko needs to fully stretch out her legs when lying down.  You can find 4" foam at  your local fabric shops to make a mattress.  Enclose it into a trash bag so no liquids can damage the foam.  Setting up recovery suite mattress plus MORE to make rest go smoother:

Most dogs do best in a wire suite during the day where the visibility is not hindered as in the one she is in now (it would make a good bedtime suite). An ex-pen might be easy for you to care for Miko getting her in and out?  A wire suite is also good.

Kendra, 

For us humans to know what a tail wag or other movements of legs, release of urine means, we need to see some sort of head level involvement.  
  --- leg or tail movement during potty time is often a reflex caused movement.  
 ---  A sniff (head level) and a release of urine shows the brain was involved to control release of urine.
 --- Miko hearing (head level) your happy talk to her or seeing you (head level) and then you observe a tail wag, shows us the brain directed the movement of the happy tail wag.

PREDNISONE TAPER
-- For a disc episode, no one knows how long pred needs to be used to get the root cause of the painful swelling gone.
    Vets just have to guess if a 10-day course will do the job. The taper tells the answer.
-- It often will take in the range of 7- 30 days on prednisone at the anti-inflammatory level.
    Taper days are not up at the anti-inflammatory level.... taper doses are too low and they are not counted in the 7-30 days.
     It may take a couple of courses adding up to the usual range.
-- This steroid hormone med must be tapered to signal the body to again produce its own steroid hormone (Cortisol). 
-- During the pred taper process, this is a perfect window for verifying if another pred course is needed.  Your job at home is to monitor for surfacing pain and any new or increased neuro loss.
-- Pain meds on board with the pred taper will naturally blindfold you about pain.  Normally, pain meds would be stopped on the same date as the start of the pred taper 6/29.
 
-- With any TAPER, it is always good to have worked out in advance a "PLAN B" with your vet should pain re-surface at night or on the weekend when your vet is not open.
    Could be an emergency RX script you could fill at local 24 hr pharmacy or some extra pills at home til the vet opens again. An ER visit to get meds adjusted is expensive, being prepared with a "Plan B" is free!  
--  The risk vs. benefit for vet visits need to be weighed. Transport risk to the healing disc vs. a phone update and a med adjustment.
-- The single most important part of care is the part at home in the recovery suite where there is limited movement of the back. Every time the vertebrae move, discs are pressured including the disc trying to heal. 


No Pain= go to TAPER conclusion...finish out the 8 weeks of crate rest for the disc to heal.

1) What is your plan B should you observe surfacing of pain or neuro decline during the taper?

2) What does your vet want on the pred taper on 6/29:
    --  Full stop of pain meds  (gabapentin & methocarbamol)?
    --  Reduction of mgs and x/day dose for all pain meds?
   
3) Let us know the details of the tail movement:
    -- Did you do some happy talk to her or did she see you approaching her?
    -- Did you see the tail movement when at potty time?

Hope you are able to figure out if Miko needs you to express her bladder or if you can confirm with the sniff and pee test that she now does have a degree of bladder control.

Another easy tip to try from one of our moderators is to put a towel warm from the dryer on the stomach to help the muscles relax. Tapping gently on the tummy to jiggle the muscles will also help relax a tight tummy.

Kendra, thank you for the details on how she peed. YES, YES, she has bladder control!

Next time spike the interior of the outdoor 6 foot diameter pen area with piece of a urine stained paper towel. Let her sniff inside the pen area. Command "go potty". She may only take FOOTSTEPS in the small pen area. Walking, even if gentle, requires too many footsteps each with opportunity for the vertebrae to press on the disc.  
    When she attempts to release urine, praise generously.  Soon she will learn to go potty on command.  
    You are in charge, she is not....only allow minimal FOOTSTEPS at potty time.  In a couple of minutes, if she has not released urine, then back inside.  Again, try pottytime in an hour or two.

Be strict about the footsteps at pottytime plus avoid or reduce back movement for everything else. Even vet visits MUST be very seriously weighed for risk to the healing disc. Most vets who know IVDD and understand especially for a dog not liking to be lifted will take phone calls for updates, for requests to adjust meds.

Your job is to be detailed and accurate with information and word so that a vet knows they can depend on what you observe with the date. You are his eyes and ears at your home, same as you are ours on this side of the computer screen.  Better than using your memory is documenting things on a med chart.
    A medication chart is useful to see patterns, have dates and specific facts handy as you discuss things with the vet.
    D/l a sample and a blank form to use with your dog's meds dodgerslist.com/wp-content/uploads/2023/12/med-chart-printable.pdf


With care to the necessary STRICT limited movement of the back type of rest, you are playing in instrumental part in her ability to heal her disc and very likely preventing a relapse to disc healing....and preventing a decline in neuro function.

Wonderful to hear you did find the right size mattress for the recovery suite.... that will make the rest of the eight weeks better for Miko's comfort!!

Don't forget to use QUICK REPLY: Easy, fast and recommended for this Forum!
Go to the "Quick reply" typing area at bottom of your dog's thread to write a reply. 

What good news that you saw a happy tail wag! A happy tail wag bodes well for future healing.

I hope that Miko's pneumonia resolves quickly. If it was caused by aspiration, see if she will eat while supported with her sling.

How is she doing with sniffing and peeing? After the happy tail wag, the typical order of function return would be bladder and bowel control. Give her lots of chances to sniff and pee.

Kendra, choking/aspiration happens when the food goes down the wrong way. Sitting on her butt when eating would be a preferable position to eat than lying down. Standing, sitting can avoid food/liquids getting into the airway. Eating too fast can also allow food to go down the wrong way into the lungs.

Attach her water/food bowls at head height inside the recovery suite.  DIY idea:

Keep us posted on what your husband observed back on 6/21 vet visit where he saw her SNIFF and then she released urine. The SNIFF part (head level involvement) with a release of urine is "the" proof if there is bladder control. Update us and let us know what the usual is. What you observe today.... is there is a SNIFF and then a release of urine?